John C. Staley

I may well be being very thick here, but what exactly is a reference range for an antibody screen?  Is it how many positive results you would expect on samples from individuals who are new to your own institution?  If it is, and I am not being completely stupid (I probably am), how can ANYONE possibly come up with such a range?
Surely, such a range depends upon al sorts of different factors, such as sex (women who have been pregnant are almost bound to have more atypical alloantibodies than either women who have not been pregnant, or males (who have never been pregnant), individuals who have been multiply transfused because of such things as Sickle Cell Disease, or thalassaemia, but even then, the atypical alloantibodies detected in such individuals depends upon factors like how many transfusions they have received, whether the donors are of the same/similar ethnicity as the individual, and, indeed, whether or not the individual is a respondent or not (or, as the great Dr/Prof Ed Snyder once lectured the British Blood Transfusion Society (BBTS) concerning patient's who have a "virtual transfusion" (they are shown a photograph of a red cell and, as a result, form an atypical alloantibody).

There are just so many variables, I cannot see how there could possibly be a "reference range", unless, as I suspect, I have got completely the wrong end of the stick/

Your comments are spot-on, Malcolm. A "reference range" is typically the expected result from normal individuals. This is fine for something like a platelet count or a creatinine quantitation (or any of the chemistries), but is absolute nonsense for an assay that has only two potential outcomes: Positive or Negative. I suppose "Indeterminant" might be a third option.
Here's your Reference Range for Antibody Screens: Positive / Negative / Indeterminant

If the model is discontinued and no parts are available for repairs, I'd say it has reached its 'end of life' - however I'll bet it will still work a long time after that before a part needs replaced (especially older, quality scopes). I can see 'end of life' for more complex or expensive equipment, but a microscope for blood bank is more of a minor equipment purchase. My 'new' scopes are student scopes that cost less than $500 and they work just fine for our purposes. 

Unfortunately, I don't have another supervisor, asst manager, or even a lead tech who can perform my competency.  And the only 2 techs who have bachelor's degrees work mainly in Micro, so they're not strong blood bankers.  But, according to CLIA, they're qualified to perform competency assessments in blood bank.  I think a lot of times these regulations look good on paper, but they don't always carry over to real world situations.  That's how people end up in supervisory positions when they have no idea how to actually do the job themselves.  There just aren't enough people who meet all of the regulatory requirements and have the knowledge and experience to do the job effectively.

My manager and myself (asst manager) both complete the same competency that the staff do in order to be able to be able to fill in at the bench if the need arises.  "This year's" competency is "good" for next year's observations.  It's hard to get done - but, we both feel it's valuable - and the staff seems to appreciate that we remain "competent" since previous management had no clue what went on at the bench....
Keeps us in the loop.

@John C. Staley - exactly...........
Our facility was just purchased by a large entity and we are having to "dig" holes that have never been dug before for their so-called "harmonization"
 

My guess is they want to know when they will be asked for money to replace them.  Apparently everything must have an "expiration or best by" date.  

Personally, I think you should respond to CAP exactly as you did in your post.  You make a logical and compelling argument.  I could say more but I think I'll stop for now and see what other responses you get.

Cliff has any thing changed recently.  For the past few days I've had to sign in every day?  Not sure how I managed but I do remember my password.

One of the highlights of my career was getting to meet with and talk to Peter.  I am saddened to learn of the passing of another great in the world of blood banking.  Please share my condolences with Marilyn.   
Malcolm, thanks for for keeping us informed.

Has anyone considered how to build for cold stored platelets in their BBIS?  SafeTraceTx at least, has expected temperature ranges for products on return from issue or delivery so we couldn't very well lump cold stored platelets in with other platelets.  I guess we could build an entirely new product class with its own temperature range.  Not that we are going to get cold-stored platelets anytime soon, much as we would love the 14-day shelf life.  We are too small and remote to keep a dual inventory for oncology vs. trauma patients.  I'm just curious how others plan to solve this issue.  After all, the driving force of our lives is keeping our computers happy, right?  Now if FDA would just approve 7-day expiration for all PR platelets!

Oh yeah! That was fun (sort of).....

My guess is the very hard part is getting the provider  (I very much dislike that term) to document the informed consent with a patient's signature.  How accessible is the form when the physician is actually with the patient?  If someone isn't there to hand the form to them they won't go looking for it.  On a side note, whose responsibility is it to make sure the form is signed and in the chart?  I certainly hope it's not the transfusion service's.  

Does anyone remember the humorous/terrifying thread on here more than a decade ago of all of the insane things we had heard of?  "I can't hang this plasma on my patient, it's liquid and the doctor ordered FROZEN plasma".  Or, "I don't care if the plasma isn't thawed yet, I need to hang it stat! Send it up now!" "I ordered that blood culture stat and it's been 2 hours.  Why don't I have a result yet?!"

My guess is the very hard part is getting the provider  (I very much dislike that term) to document the informed consent with a patient's signature.  How accessible is the form when the physician is actually with the patient?  If someone isn't there to hand the form to them they won't go looking for it.  On a side note, whose responsibility is it to make sure the form is signed and in the chart?  I certainly hope it's not the transfusion service's.  

We scan them monthly to a storage file where we can retrieve anytime, We discard scanned invoices afterwards

WE provide Adsol units, predominantly and our NICU is over 70 beds.  Prisma Health Greenville Memorial Hospital

Thanks Cliff.  Just noticed I didn't have to sign in.  To be honest, I was surprised I even remembered my password!!

Thanks Cliff.  Just noticed I didn't have to sign in.  To be honest, I was surprised I even remembered my password!!

Ugh, sorry about this.  I made the bad decision to update the software just before my license ran out.  THEN they release a patch for this issue.
I need to renew the licenses and install the patch, I'll take care of it soon.

This should be fixed now.

I know the feeling.  I once cross-matched for a patient who was a Jehovah's Witness who said that they had never been transfused.  The only trouble was that their serum/plasma contained one of the strongest anti-Fya's that I ever saw throughout my career!!!!!!!!

While it is infrequently referenced, universal leukoreduction is one strategy for minimizing pulmonary and cardiovascular adverse responses to transfusion (see attached).  When we instituted it in 2000 our rate of TRALI decreased by 80+ % and TACO decreased by 50%.  Probably mechanism is that white cells, DNA, histones and neutrophil extracellular traps (NETs) cause acute lung injury and inflammation when infused (good animal model data exist).  Thus the failure to implement universal leukoreduction in the USA during the last 23-25 years was a terrible and tragic mistake, and this fatal error persists to this day.
ULR TRALI TACO PMC version.pdf

My own experience with an antibody card that would have been useful, from 2007.  Slides 5 and 25 are of particular interest from my own point of view!  It should be noted that I no longer work for the NBS/NHSBT, and am no longer entitled to put CSci FIBMS after my name, although I am entitled to put FBBTS after it.  Funny old world!
COADOA.ppt

Especially slide 25  .